II. The Legal Framework

The constitutional framework for end-of-life care in India began with Gian Kaur v. State of Punjab.^[3] The Court famously observed that “Article 21 is a provision guaranteeing protection of life and personal liberty and by no stretch of imagination can 'extinction of life' be read to be included in 'protection of life'.”^[4] The case properly criminalised the active, unnatural termination of a healthy life and intentionally protected the passive acceleration of conclusion of the process of natural death which had already commenced.

This distinction was applied to clinical practice in Aruna Ramchandra Shanbaug v. Union of India,^[5] where the Court acknowledged that the artificial administration of nutrition and hydration was regarded as a part of life support systems and withdrawal of the same would constitute passive euthanasia. This decision should have resolved any remaining ambiguity about the legal status of CANH. However, the bench ultimately declined to order withdrawal of the petitioner's own feeding tube on the basis that the nursing staff who had cared for her opposed the measure and said that she was not 'machine-dependent' because she could breathe on her own and swallow mashed food reflexively. Therefore, the Court refrained from drawing a formal legal distinction between CANH and ordinary assisted feeding.

Common Cause v. Union of India^[6] advanced the law on advance directives and the withdrawal of ventilators but did not expressly address CANH. CANH continued to occupy a legally indeterminate position: it was not clearly a medical treatment subject to withdrawal but it was not clearly excluded from that category either.

III. The Delhi High Court Order

This ambiguity produced the Delhi High Court's order of July 2, 2024 which denied the petition of Harish Rana's parents. Harish had been sustained entirely by a PEG tube for over thirteen years due to a catastrophic brain injury which had no clinical prospect of neurological recovery. The High Court refused the petition in the following terms:

“The Apex Court, in the abovementioned Judgements, has held that active euthanasia is legally impermissible. The Petitioner is not on any life support system and the Petitioner is surviving without any external aid. While the Court sympathises with the parents, as the Petitioner is not terminally ill, this Court cannot intervene and allow consideration of a prayer that is legally untenable.”^[7]

This decision that the petitioner was “surviving without any external aid” does not accurately describe the clinical situation. A PEG tube is inserted under endoscopic guidance, creates a surgically maintained tract through the abdominal wall, delivers a medically formulated liquid diet and requires ongoing clinical monitoring for complications including infection, aspiration and tube displacement. The fact that the petitioner could breathe without mechanical ventilation does not imply he did not require any external medical intervention to sustain his biological functions. The High Court conflated respiratory independence with the absence of medical dependency more generally.

The petition sought the withdrawal of a medical treatment which is a passive omission. Active euthanasia involved an affirmative act of causing death. These distinct categories are foundational to the entire line of authority from Gian Kaur onwards. The High Court treated the absence of a terminal diagnosis as a legal bar to the petition. The legally relevant criterion in PVS cases is not whether death is imminent in the ordinary clinical sense but whether the patient's neurological condition is irreversible and whether continuation of treatment serves any therapeutic purpose. A patient may remain in a vegetative state for many years without meeting the clinical definition of terminal illness.

IV. The Supreme Court's Reclassification of CANH

The Supreme Court addressed the classification question by reference to comparative jurisprudence from the United States, New Zealand and the United Kingdom, each of which had addressed the CANH question in analogous fact situations. Drawing on In re Conroy^[8], the Court noted that CANH methods are “significantly different from bottle feeding or spoon feeding. It prolongs life through mechanical means when the body is no longer able to perform a vital bodily function.” This passage was used to establish the clinical distinction that Indian courts had previously left unresolved. The Court also addressed the argument that CANH should not be classified as a medical procedure because it can, in some contexts, be administered at home by a non-clinician. The bench held that merely because routine feeding in the form of CANH can be administered at home, by an informed layman, it cannot be relegated to non-medical status. Regardless of the situation, it still serves a therapeutic and medical function by enabling the patient to survive long enough for recovery. The Court weighed the burdens of continuing treatment against its benefits. For a patient with no cognitive capacity, no relational awareness and no prospect of neurological recovery, continued CANH served no therapeutic purpose. It amounted to maintaining biological function without any corresponding benefit to the patient as a person.

V. The Criminal Law Shield Under Section 100 BNS

The reclassification of CANH as a medical treatment has direct consequences for the criminal exposure of physicians. Prior to Harish Rana, the unresolved status of CANH created meaningful uncertainty about whether a doctor who withdrew a feeding tube after obtaining family consent could face liability under Section 100 BNS. The judgement addresses this in three respects.

First, on the act/omission distinction: since CANH is a medical treatment, its withdrawal is a passive omission rather than an affirmative act. A physician has no legal duty to continue a treatment that has been determined to be clinically futile. An omission cannot ground criminal liability in the absence of duty to act and no such duty exists with respect to futile treatment.

Secondly, the Court clarified that the proximate legal cause of death in a PVS case is the original injury that destroyed the patient's capacity for independent neurological function. The act of withdrawing the tube does not displace that as the operative cause of death.

Thirdly, Section 100 BNS^[9] attaches criminal liability to dangerous acts committed with mens rea that death is the probable outcome “without any excuse.” The Court held that a physician's formal clinical determination of therapeutic futility when made in accordance with established due process constitutes the 'lawful excuse' that the provision inherently requires. The requisite criminal intent is absent where the physician's purpose is to discontinue a futile intervention rather than to cause death.

Together these three elements provide a coherent doctrinal basis for protecting physicians who act in accordance with the framework established by Common Cause and Harish Rana.

Harish Rana v. Union of India resolves a question that Indian courts had deferred since Aruna Shanbaug: whether CANH is a medical life-support intervention or a form of basic care. The Court's answered that CANH is certainly a medical treatment and its withdrawal falls within the scope of lawful passive euthanasia. The ruling corrected the approach of treating the presence or absence of a ventilator as the sole criterion for passive euthanasia eligibility.

However, the protections the judgement provides are judge-made and must be actively litigated. The absence of a statutory framework remains a serious gap. Parliament must act to replace this judicial protection with an End-of-Life Care Act. Until then, Harish Rana stands as a firm reminder that Article 21 protects not merely the fact of life but also its quality and that dignity at the end of life is as fundamental a right as dignity throughout life is.

1. Harish Rana v. Union of India 2026 INSC 222. ↑

2. § 100, Bharatiya Nyaya Sanhita, 2023. ↑

3. Gian Kaur v. State of Punjab (1996) 2 SCC 648. ↑

4. Ibid, 9. ↑

5. Aruna Ramchandra Shanbaug v. Union of India (2011) 4 SCC 454. ↑

6. Common Cause v. Union of India (2018) 5 SCC 1. ↑

7. Harish Rana v. Union of India & Ors 2024 DHC 4988, ¶ 8. ↑

8. In re Conroy 98 N.J. 321. ↑

9. § 100, Bharatiya Nyaya Sanhita, 2023. ↑